Anaphylaxis

Anaphylaxis (or anaphylactic shock) is a severe allergic reaction that can occur after an insect sting or after eating certain foods. The adverse reaction can be very fast, occurring within seconds or minutes of coming into contact with the substance the person is allergic to (allergen).

During anaphylactic shock, it may be difficult for the person to breathe, as their tongue and throat may swell, obstructing their airway.

Call 999 or 112 immediately if you think someone is experiencing anaphylactic shock.

Check if the person is carrying any medication. Some people who know they have severe allergies may carry an adrenaline self-injector, which is a type of pre-loaded syringe. You can either help the person administer their medication or, if you're trained to do so, give it to them yourself.

After the injection, continue to look after the person until medical help arrives. All casualties who have had an intramuscular or subcutaneous (under the skin) injection of adrenaline must be seen and medically checked by a healthcare professional as soon as possible after the injection has been given.

Make sure they're comfortable and can breathe as best they can while waiting for medical help to arrive. If they're conscious, sitting upright is normally the best position for them.

Bleeding

If someone is bleeding heavily, the main aim is to prevent further blood loss and minimise the effects of shock (see below).

First, dial 999 and ask for an ambulance as soon as possible.

If you have disposable gloves, use them to reduce the risk of any infection being passed on.

Check that there's nothing embedded in the wound. If there is, take care not to press down on the object.

Instead, press firmly on either side of the object and build up padding around it before bandaging, to avoid putting pressure on the object itself.

If nothing is embedded:

apply and maintain pressure to the wound with your gloved hand, using a clean pad or dressing if possible; continue to apply pressure until the bleeding stops

use a clean dressing to bandage the wound firmly

if bleeding continues through the pad, apply pressure to the wound until the bleeding stops and then apply another pad over the top and bandage it in place; don't remove the original pad or dressing, but continue to check that the bleeding has stopped

If a body part, such as a finger, has been severed, place it in a plastic bag or wrap it in cling film and make sure it goes with the casualty to hospital.

Haemostatic dressings and tourniquets

In certain situations, where bleeding is very severe and from the body's extremities, such as the head, neck and torso, it may be appropriate to use haemostatic dressings or a tourniquet.

Haemostatic dressings contain properties that help the blood to clot (thicken) quicker. A tourniquet is a band that's wrapped tightly around a limb to stop blood loss. Haemostatic dressings and tourniquets should only be used by people who have been trained to apply them.

Burns and scalds

If someone has a burn or scald:

cool the burn as quickly as possible with cool running water for at least 20 minutes, or until the pain is relieved

call 999 or seek medical help, if needed

while cooling the burn, carefully remove any clothing or jewellery, unless it's attached to the skin

if you're cooling a large burnt area, particularly in babies, children and elderly people, be aware that it may cause hypothermia (it may be necessary to stop cooling the burn to avoid hypothermia)

cover the burn loosely with cling film; if cling film isn't available, use a clean, dry dressing or non-fluffy material; don't wrap the burn tightly, because swelling may lead to further injury

don't apply creams, lotions or sprays to the burn

For chemical burns, wear protective gloves, remove any affected clothing, and rinse the burn with cool running water for at least 20 minutes to wash out the chemical. If possible, determine the cause of the injury.

In certain situations where a chemical is regularly handled, a specific chemical antidote may be available to use.

Be careful not to contaminate and injure yourself with the chemical, and wear protective clothing if necessary.

Choking

Mild choking

If the airway is only partly blocked, the person will usually be able to speak, cry, cough or breathe. In situations like this, a person will usually be able to clear the blockage themselves.

If choking is mild:

encourage the person to cough to try to clear the blockage

ask them to try to spit out the object if it's in their mouth

don't put your fingers in their mouth to help them because they may accidentally bite you

If coughing doesn't work, start back blows (see below).

Severe choking

If choking is severe, the person won't be able to speak, cry, cough or breathe, and without help they'll eventually become unconscious.

To help an adult or child over one year old:

Stand behind the person and slightly to one side. Support their chest with one hand. Lean the person forward so that the object blocking their airway will come out of their mouth, rather than moving further down.

Give up to five sharp blows between the person's shoulder blades with the heel of your hand (the heel is between the palm of your hand and your wrist).

Check if the blockage has cleared.

If not, give up to five abdominal thrusts (see below).

Don't give abdominal thrusts to babies under one year old or to pregnant women.

To perform abdominal thrusts on a person who is severely choking and isn't in one of the above groups:

Stand behind the person who is choking.

Place your arms around their waist and bend them well forward.

Clench one fist and place it just above the person's belly button.

Place your other hand on top of your fist and pull sharply inwards and upwards.

Repeat this up to five times.

The aim is to get the obstruction out with each chest thrust, rather than necessarily doing all five.

If the person's airway is still blocked after trying back blows and abdominal thrusts:

Call 999 and ask for an ambulance. Tell the 999 operator that the person is choking.

Continue with the cycles of five back blows and five abdominal thrusts until help arrives.

The person choking should always be seen by a healthcare professional afterwards to check for any injuries or small pieces of the obstruction that remain.

Drowning

If someone is in difficulty in water, don't enter the water to help unless it's absolutely essential.

Once the person is on land, if they're not breathing, open the airway and give five initial rescue breaths before starting CPR. If you're alone, perform CPR for one minute before calling for emergency help.

If the person is unconscious but still breathing, put them into the recovery position with their head lower than their body and call an ambulance immediately.

Continue to observe the casualty to ensure they don't stop breathing or that their airway becomes obstructed.

Electric shock (domestic)

If someone has had an electric shock, switch off the electrical current at the mains to break the contact between the person and the electrical supply.

If you can't reach the mains supply:

don't go near or touch the person until you're sure the electrical supply has been switched off

once the power supply has been switched off, and if the person isn't breathing, dial 999 or 112 to for an ambulance

Afterwards, seek medical help – unless the electric shock is very minor.

Fractures

It can be difficult to tell if a person has a broken bone or a joint, as opposed to a simple muscular injury. If you're in any doubt, treat the injury as a broken bone.

If the person is unconscious, has difficulty breathing or is bleeding severely, these must be dealt with first, by controlling the bleeding with direct pressure and performing CPR.

If the person is conscious, prevent any further pain or damage by keeping the fracture as still as possible until you get them safely to hospital.

Assess the injury and decide whether the best way to get them to hospital is by ambulance or car. For example, if the pain isn't too severe, you could transport them to hospital by car. It's always best to get someone else to drive, so that you can deal with the casualty if they deteriorate – for example, if they lose consciousness as a result of the pain or start to vomit.

However, if:

they're in a lot of pain and in need of strong painkilling medication, don't move them and call an ambulance

it's obvious they have a broken leg, don't move them, but keep them in the position you found them in and call an ambulance

you suspect they have injured or broken their back, don't move them and call an ambulance

Don't give the casualty anything to eat or drink, because they may need an anaesthetic (numbing medication) when they reach hospital.

chest pain – the pain is usually located in the centre or left side of the chest and can feel like a sensation of pressure, tightness or squeezing

pain in other parts of the body – it can feel as if the pain is travelling from the chest down one or both arms, or into the jaw, neck, back or abdomen (tummy)

Sit the person down and make them comfortable.

If they're conscious, reassure them and ask them to take a 300mg aspirin tablet to chew slowly (unless you know they shouldn't take aspirin – for example, if they're under 16 or allergic to it).

If the person has any medication for angina, such as a spray or tablets, help them to take it. Monitor their vital signs, such as breathing, until help arrives.

If the person deteriorates and becomes unconscious, open their airway, check their breathing and, if necessary, start CPR. Re-alert the emergency services that the casualty is now in cardiac arrest.

Poisoning

Poisoning is potentially life-threatening. Most cases of poisoning in the UK happen when a person has swallowed a toxic substance, such as bleach, taken an overdose of a prescription medication, or eaten wild plants and fungi. Alcohol poisoning can cause similar symptoms.

If you think someone has swallowed a poisonous substance, call 999 or 112 to get immediate medical help and advice.

The effects of poisoning depend on the substance swallowed, but can include vomiting, loss of consciousness, pain or a burning sensation. The following advice is important:

Find out what's been swallowed, so you can tell the paramedic or doctor.

Do not give the person anything to eat or drink unless a healthcare professional advises you to.

Do not try to cause vomiting.

Stay with the person, because their condition may get worse and they could become unconscious.

If the person becomes unconscious while you're waiting for help to arrive, check for breathing and, if necessary, perform CPR.

Don't perform mouth-to-mouth resuscitation if the casualty's mouth or airway is contaminated with the poison.

Don't leave them if they're unconscious because they may roll onto their back, which could cause them to vomit. The vomit could then enter their lungs and make them choke.

If the casualty is conscious and breathing normally, put them into the recovery position and continue to monitor their conscious state and breathing.